The silent killers

If someone wishes for good health, one must first ask oneself if he is ready to do away with the reasons for his illness, only then is it possible to help him.~ Hippocrates

Diseases are adverse health conditions, which can impact the overall well-being of an individual and can occur by 'chance' or 'choice'. For centuries, communicable diseases (CDs) were the main factors responsible for deaths around the world. Life expectancy was often limited by uncontrolled epidemics. The fight against AIDS, as well as tuberculosis and many other CDs, is far from over in spite of medical research and achievements in terms of vaccination, antibiotics and improvement of life conditions. While CDs continue to grip many parts of the world with fear, research by the World Health Organisation (WHO) and leading epidemiologists has identified another global epidemic and the biggest killers.

These are not contagious or chronic diseases. They can be prolonged and are usually the result of a combination of genetics, physiological, environmental and behavioural factors. The other stark feature of these disorders is their ability to affect any human being world over without barriers of geography, race, ethnicity, region or religion. The 'noncommunicable disease' (NCD) cases ~ heart ailment, stroke, obesity, Type 2 diabetes, cancer, respiratory diseases, etc. ~ all share common risk factors, including unhealthy diet, a sedentary lifestyle, smoking and chewing tobacco, and a huge consumption of alcohol. Though the risk factors for many of these illnesses also rooted in our DNA, the trigger to their early onslaught and unmanageable is definitely one's lifestyle. Most of the NCDs are referred to as 'lifestyle' diseases which are not restricted to adults alone, they have started affecting children as well. The shift in purchasing power and the advent technology have changed our way of life. With less physical activity, greater availability of resources and little or no time to spare, we have become vulnerable to ailments that were unheard of in the 1960s and Seventies.

There is evidence that the poorest members of society and malnourished children are at risk. For some, vulnerability begins in the womb. Dr. David Barker's theory, coined as Barker Hypothesis by the British Medical Journal in 1995, states that "maternal dietary imbalances" at the critical period of development of the womb can trigger an adaptive redistribution of the foetal resources in such a way that such adaptation and metabolism predispose individuals to NCDs like heart diseases, obesity and diabetes later in life.

According to WHO's Global Status Report on Noncommunicable Diseases 2010, NCDs are sweeping the world and appear to be the leading factors behind death, killing more people every year than other causes combined. In the introduction to the report it is also mentioned that "of the 57 million deaths that occurred globally in 2008, 36 million ~ almost two-thirds ~ were due to NCDs, notably cardiovascular problems, cancer, diabetes and chronic lung diseases. The combined burden of such ailments is rising fastest among lower-income countries, populations and communities, where they impose large, avoidable costs in human, social and economic terms. About one-fourth of global NCD-related deaths take place before the age of 60."

Going by the updated statistics of WHO, NCDs kill about 40 million people each year, equivalent to 70 per cent of all deaths globally. And four groups of the most common diseases ~ cardiovascular, cancer, respiratory ailments and diabetes ~ account for over 80 per cent of all premature NCD deaths. The ailment not only affects health but also productivity and economic growth. It appears from the latest fac-sheet of WHO that every year 15 million people die from NCDs between the ages of 30 and 69 years; over 80 per cent of these 'premature' deaths occur in low and middle-income countries. Premature deaths, illnesses and disabilities at a young age impact heavily on socio-economic development and productivity. By 2020, it is predicted that NCDs will account for around 80 per cent of the global burden of disease, causing seven out of every ten deaths in developing countries, compared with less than half today. It is also feared in the report that among the poor people of low- and middle-income countries 'a vicious cycle may ensure: poverty exposes people to behavioral risk factors for NCDs and ,in turn, the resulting NCDs may become an important driver to the downward spiral that leads families towards poverty. As a result, unless the NCD epidemic is aggressively confronted in the most heavily affected countries and communities, the its mounting impact will continue and the global objective of reducing poverty will be undermined.

The first health-of-the-nation report, India: Health of the Nation's States, prepared as part of the Global Burden of Disease (GBD) Study 2016, has recently been published. The report provides estimates of the impact of 333 disease conditions and injuries and 84 risk factors for every state from 1990 to 2016. In 2016, NCDs, which include heart ailments, cancer, diabetes, chronic respiratory diseases and mental disorders, accounted for 61.8 per cent of the total deaths. CDs, maternal, neonatal and nutritional diseases accounted for 27.5 per cent and injuries accounted for the rest. NCDs took the heaviest toll in all states, but relatively more in Tamil Nadu, Kerala, Punjab and Goa. In the Partnership to Fight Chronic Disease (PECD), India has stated that NCDs account for 53 per cent of the "disease-burden" in the country and more than six out of ten people die from NCDs. It is reported that roughly 5.8 million Indians die every year due to NCDs; it has been projected that by 2025 roughly 7 million Indians will die. The pertinent question that arises is: Are Indians more susceptible to many of the lifestyle disease?

Over the years, much work has been done towards estimating the human toll of NCDs, but work on assessing the economic toll is far less advanced. However, a report titled The Global Economic Burden of Non-Communicable Diseases 2011 of the World Economic Forum and the Harvard School of Public Health states that NCDs already pose a substantial economic burden and over the next 20 decades the burden will be more than $30 trillion, representing 48 per cent of the global GDP in 2010 and pushing millions of people below the poverty line. Although high-income countries currently bear the biggest economic burden of NCDs, the developing world, especially middle-income countries, is expected to assume an ever larger share as their economies and population grow.

Another report titled Economics of Non-Communicable Diseases in India, 2014, crafted by the World Economic Forum and the Harvard School of Public Health examines the economic impact of such diseases to the Indian economy. It has been calculated that the country stands to lose $4.58 trillion before 2030 due to NCDs and mental health conditions. Moreover, lifestyle diseases can impede workforce productivity by increasing the rates of absenteeism, diminishing the energy and focus on workers, and depleting critical workplace skills. Let us examine the most common types of lifestyle diseases affecting us as a race and a geographical entity.

Cardiovascular diseases (like heart attacks and stroke) have emerged as the top contender among others to be responsible for causing the maximum mortality globally as well as in India. Over six million people died of NCDs in India in 2016, with Ischemic heart being the leading cause of death, according to the findings of the 2016 study that has recently been published in the medical journal, The Lancet. Genetically, Indians are susceptible to high cholesterol levels and diabetes.

This has assumed an epidemic proportion. High blood pressure, smoking and diabetes are among the factors known to increase the risk of stroke, a condition in which the blood supply to a region of the brain is obstructed or a blood vessel in the brain bursts.

Nearly 15% the planet's adult population smokes. Tobacco is the world's leading preventable cause of death, responsible for the death of six million people yearly. About one in ten of those deaths are caused by cardiovascular disease. Smoking impacts circulation by narrowing the arteries, damaging the lining of blood vessels and increasing the risk of blood clots. This more than doubles the risk of suffering a heart attack or stroke and shortens a smoker's life by about a decade. Drinking is also a massive problem.

Each year, alcohol kills more people than AIDS and tuberculosis combined, about 2.5 million in all, including more than 3 lakh individuals who have not yet reached their 30th birthday. Those deaths are due to injury, cirrhosis of liver, cancer and heart ailments. Heavy drinking can raise blood pressure and increase the risk of stroke. It enlarges the heart and raises harmful triglycerides.

Another contender that is trying to attain the No. One position in terms of mortality rates is diabetes. India is home to the highest number of diabetics; roughly 30 million and growing daily. It has been predicted that the country will be saddled by 80 million diabetics by 2030. Type 1, an autoimmune condition and Type 2, an insulin-malfunction condition have become a possible threat for every human life. Several studies highlight the nutritional status of ancestors to be the major "causative factor", apart from lifestyle changes. Generations of malnutrition followed by rapid changes of lifestyle have led to a surge in the number of people affected by metabolic disorders.

Every biochemical activity is coded in our DNA and the sudden increase in energy-dense food has caused severe alterations at the epigenetic level, resulting in obesity. Certain factors behind Type 2 diabetes have been identified, and this makes Indians and South Asians generally more prone to suffer than their European counterparts.

Such dissonances have been collectively termed as 'evodeviation'. This implies that human cultural evolution, determining the sources and methods of food production, has occurred at an ever-increasing pace, whereas human biology has simply not had time to adapt to the evolutionary process. Lack of exercise, unhealthy eating habits and stress are to an extent manageable.

Obesity is the most visible and yet most neglected non-communicable disease. Without immediate action, millions suffer from an array of serious health disorders because of growing overweight and obesity. Joint disorders like osteoarthritis, diabetes, heart diseases, etc. are among the consequences. Obese populations have a 69 per cent higher risk of coronary heart disease and a 47% greater chance of suffering a stroke than those with normal weight.

Obesity is one of the major public health challenges of the 21st century. India is ranked to be third most obese country in the world. The country is now battling both obesity and malnutrition. In India, two in five children are malnourished, yet one in five is overweight. Over-reliance on proceed foods rich in fat and sugar are responsible for abdominal obesity.

Certain types of cancers can be attributed to familial/genetic disorders. Cancer of the breast and colon have been linked to obesity, while consumption of tobacco and diet with a high salt content can cause tongue, oral and gastrointestinal cancer. Obesity and sedentary lifestyle have been linked to around 13 different types of cancer. Treatment of cancer entails a huge expenditure, driving poor families to penury.

If these lifestyle diseases are not checked, this 'slow-motion disaster' (a term coined by former WHO Director General Margaret Chan) could render struggling nations bankrupt and leave citizens further mired in poverty. NCDs threaten progress towards the 2030 Agenda for Sustainable Development, which includes a target of reducing premature deaths from NCDs by one-third by 2030 through prevention and treatment.

With so many proven statistics in hand, it is imperative to tighten our laces, strengthen our collective action to take the steps required for the optimal approach to the prevention and control of such ailments. An active lifestyle, healthy diet and the need to avoid smoking, drinking and drugs must be encouraged.

In the words of Paul Bulcke, CEO, Nestle, Switzerland: 'We speak about healthcare, and most of the time we are talking about caring for sick people, not caring about health. At the end of the day, health is not something you 'use', it is something you keep. But we can only create and 'keep' health by working together to provide a broad health-promoting ecosystem with the individual at the centre.'